The Legionnaire Insurance Trust Insurance my wife and I obtained through the American Legion stinks.
This insurance pays predetermined amounts for specifically covered health care service. One service covered by our policy is Outpatient Surgical Benefit.
Recently, my wife required outpatient surgery for a kidney problem.
It would seem that documentation by the surgeon would be adequate validation of the service provided.
NO! CIGNA, the parent company for this insurance, requires the following information for our claim to be considered:
1 - itemized hospital bill
2 - itemized surgeon bill
3 - completion of an 8 x 11 form by the surgeon
4 - list of all hospitals, clinics or physicians that treated the patient during the past two years.
Have you folks ever dealt with AFLAC? That insurance is also coverage that pays a specific amount for specific services. The AFLAC claims process requires only the documentation necessary to verify that the covered service was in fact provided.
If Legionnaire Insurance Trust Insurance were paying for all the specific items involved in this Outpatient Surgical service, the extensive details CIGNA requires would be appropriate, but Legionnaire Insurance Trust Insurance pays a fixed benefit for Outpatient Surgery.
Itemized bills and two year health care histories are far in excess of validating the covered service was provided.
The only reason to have such a bureaucratic claim process is to have reasons for denying the claim.
If there is any positive from the Legionnaire Insurance Trust Insurance, it is as an example of the excessive paperwork that contributes to America's excessive health care costs.
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